4 Ways Ketogenic Diet Benefits in Rheumatoid Arthritis (Dosage, Precautions)

Rheumatoid arthritis(RA) is a disease in which the body’s immune system attacks its own healthy cells.

This causes inflammation, swelling, pain, and redness of the bone joints. It can affect any joint of the body [1].

Rheumatoid arthritis mostly affects women than men [2].

The exact cause of rheumatoid arthritis is not identified but it may be related to genetic, environmental and hormonal factors [3].

Inflammation involves the accumulation of immune cells (that protect the body from foreign substances) at the joints which are brought about by biochemical compounds called inflammatory mediators [4].

Diet control can have a great influence on disease control [5]. One such unique diet proposed to reduce inflammation is called Ketogenic Diet.

Before we discuss its benefits let us know a little about this diet.

What is a Ketogenic Diet?

The ketogenic diet is a fat rich and low carbohydrate diet.

The carbohydrates consumed in a normal diet are converted to glucose and used as energy. The fats in the diet are usually stored in the body [6].

When there is a low intake of carbohydrate in the diet the body is forced to metabolize fat. This allows the body to depend on fat rather than glucose [7].

Fat metabolism results in the release of ketones (product of fat metabolism in the body) into the blood, which provides energy to the body. This state of increased ketones in the body is known as ketosis [8].

A ketogenic diet mainly focuses on achieving the state of ketosis and these ketones provide the energy required for the body’s functions [9].

The total calorie intake is restricted to three-fourths of the normal calorie intake but, the volume may appear much smaller [10].

Does Ketogenic Diet Benefit in Rheumatoid Arthritis?

The Ketogenic diet can help in rheumatoid arthritis in several ways. The ketogenic diet has anti-inflammatory effect thus can provide relief to patients with rheumatoid arthritis. It also helps in symptoms of RA such as pain and difficulty in movement. The ketogenic diet can also benefit in rheumatoid arthritis by fighting against depression and numbness associated with it.

Diet can greatly influence the cellular functions. A change in the diet also causes a change in the cellular function which may help in causing a change in the disease state [11]. Let us find out if this diet can really benefit in rheumatoid arthritis.

1. Ketogenic Diet has an Anti-inflammatory Effect

A ketogenic diet which has been proven to be beneficial in brain disorders by reducing inflammation it can provide relief in rheumatoid arthritis patients as the mechanism of inflammation is similar [12].

Fatty acids are known to cause a change in immune cell function and provide significant benefits in rheumatoid arthritis [13].

As a ketogenic diet is rich in fat it might have an advantage in reducing inflammation.

The state of ketosis achieved due to a ketogenic diet has led to a proven decrease in inflammation in animal studies [14].

Studies in animals have demonstrated the anti-inflammatory properties of a ketogenic diet by reducing the synthesis of inflammatory mediators [15].

A recent review of medical literature claims that a ketogenic diet reduces inflammation [16].

This may help in rheumatoid arthritis patients as the main problem in rheumatoid arthritis is inflammation.

What does this mean? Ketogenic diet helps RA patients by reducing inflammation in the body. High fat content of this diet is the key factor for this effect.

2. Reduction in RA Symptoms and Pain

A clinical trial study showed that ketogenic diet reduced morning stiffness in rheumatoid arthritis patients [17].

Fats are responsible for an improvement in RA symptoms and may cause a reduction in drug usage [18] .

Consumption of n-3-fatty acids ( fish, flaxseed, oils etc. ) in the diet helps alters the biochemical response in the body and may provide benefits to RA patients [19].

Another clinical trial involving thirteen rheumatoid arthritis patients conducted by Fraser DA et. al. , concluded that there were no benefits of a ketogenic diet on disease activity and immune response changes [20] .

In animal studies, ketogenic diet shows great potential for reducing pain along with inflammation [21]. Pain forms a major symptom of rheumatoid arthritis and the use of painkillers is common in RA patients.

If ketogenic diet could reduce pain, then it could drastically reduce the use of painkillers.

What does this mean? Ketogenic diet reduces morning stiffness experienced by RA patients. It also has pain relieving action which can reduce the use of pain killers.

3. Relief from Numbness and Depression in RA

Rheumatoid arthritis can also cause certain neurological problems ( numbness of the hands/feet and muscle pain) [22].

Various studies that prove the benefit of a ketogenic diet for such problems are summarized below:

• Brain Cell Protection: Ketogenic diet provides nerve cell protection by increasing the energy levels and reducing reactive oxygen species (molecules that cause cell damage) [23]
• Reduce inflammatory mediators: A rise in ketones and reduced blood glucose is also linked to reducing inflammation by numerous biochemical mechanisms [24]
• Reduced Pain and Numbness: Animal studies have proven to benefit in relieving neuropathy (numbness and pain in arms and legs) [25]

Anti-epilepsy drugs are used for neuropathic pain as well. Therefore, the mechanism underlying in this reduction of numbness and pain can be attributed to the anti-seizure effects of ketogenic diets [26].

Rheumatoid arthritis is also known to cause mood problems and depression. Two animal studies have concluded that ketogenic diet possesses anti-depressant properties [27].

The use of ketogenic diet has shown improved physical activity by increasing happy brain chemicals (serotonin and dopamine) in animals [28]. This anti-depressant effect is yet to be confirmed by human studies.

What does this mean? Ketogenic diet increases cell energy and prevents cell damage which has a positive effect in reducing numbness and depression caused in certain RA patients.

4. Benefits of Keto-Diet on Weight Reduction and Prevention of RA

It has been demonstrated that obese patients have a moderate risk of developing RA [29].

A ketogenic diet can be an excellent diet to reduce body weight as proven by trials [30].

This may lead to a reduced risk of developing rheumatoid arthritis.

The long-term (upto 24 weeks) use of ketogenic diet in obese patients is also proven to be safe [31].

It is also demonstrated in a study that this diet reduces muscle mass and keeps the muscle strength intact [32].

The use of ketogenic diet in obese patients showed a decrease in weight of subjects along with reduced bad (LDL) cholesterol and an increase in good (HDL) cholesterol [33].

A high-fat diet is generally related to obesity which is known to cause chronic inflammation but, ketogenic diet differs from this type of diet by increasing the fat metabolism rather than fat storage as in case of a high-fat diet [34].

What does this mean? Ketogenic diet is proven in causing weight reduction in obese patients. This can prevent RA as obesity is risk factor for causing RA.

Possible Side Effects of Ketogenic Diet

At the beginning of this type of diet, one may experience something called as a ‘keto flu’.

It causes fever, dizziness and other flu-like symptoms as the body is switching from carbs to fat [35]. It may last a for a couple of days.

A long-term ketogenic diet has shown to produce a reduction in bone mineral content in children [36].

Low bone mineral density is associated with disease severity in rheumatoid arthritis patients [37].

A ketogenic diet may cause constipation, it can be avoided by a high intake of fiber in the diet [38].

It can also cause low blood sugar, inflammation of the pancreas and some kidney problems [39].

What to Eat on a Ketogenic Diet?

A ketogenic diet is rich in fat and contains adequate protein.

It mainly includes meats, eggs, sausages, cheeses, fish, nuts, butter, margarine, mayonnaise, oils, seeds, and fibrous vegetables [40].

A typical ketogenic diet includes a blend of these fat rich and low carbohydrate foods. It contains 4 grams of fat for every 1 gram of carbohydrate and protein combined i.e., a 4:1 ratio [41].

The fats in the diet must include saturated fat (chicken, butter/ghee), monounsaturated (avocado, macadamia, olive oil) , poly-unsaturated omega-3 fatty acids ( fish and seafood) [42].

The calorie intake restriction may differ for each individual and must be calculated separately by a dietician or physician [43].

The diet must also include certain vitamin supplements based on different individuals and their disease conditions [44].

Chicken broth intake can reduce flu-like symptoms during the beginning of this diet [45].

Diet planning is a strict necessity for following a ketogenic diet. The measurements must be accurate.

One must not skip meals as it might cause failure in providing the required energy to the body [46].

What to Avoid in a Ketogenic Diet?

A ketogenic diet requires a person to avoid carbohydrates and sugary foods. One must refrain from sweets, cakes, candies, sodas, pasta, rice, chapati, gravies, sauce etc [47].

Fruits rich in carbohydrates like apple, blueberries, banana, mango, pineapple etc., must be avoided [48].

Vegetables like potatoes, beans, grains, peas, onions, corn etc., must also be avoided in a ketogenic diet [49].

However, a very small amount (0.5-50g) of carbohydrates can be included in the diet [50].

Precautions Before Starting a Ketogenic Diet

There are no potential adverse effects of the ketogenic diet but, caution must be observed in some conditions.

There is a chance of increased blood pressure in patients with kidney disease and obesity and they must follow the diet with utmost care and guidance of physicians [51].

Although the ketogenic diet has been rendered safe for diabetic patients, caution is advised in patients with diabetes along with kidney disease and it must be supervised by a health professional [52].

The diet should not be used in case of infants and young children [53].

The use of a long-term ketogenic diet is not studied in patients above 50years of age and therefore it must be avoided [54].

A high protein ketogenic diet may cause some kidney damage but, this can be avoided by the consumption of adequate protein in the ketogenic diet [55].

The ketogenic diet should not be taken in patients with metabolic syndrome, where there is high blood pressure, high blood sugar and abnormal cholesterol levels with increased risk for cardiovascular disease [56].

A ketogenic diet is absolutely contraindicated in case of some biochemical process abnormalities and starting this requires a physician's assistance to rule out these factors [57].

Ketogenic diets have been proven to be safe in many studies but this does not mean that it can be started without a physician and dieticians advice.

Conclusion

The ketogenic diet is gaining popularity for their benefits in various disease conditions like epilepsy, diabetes, obesity, neurological problems etc.

It has been proposed to be used in rheumatoid arthritis owing to its advantages in reducing inflammation, numbness, and pain.

This diet requires high levels of determination and planning. It must be carried out under the supervision of a dietician and physician.

Minimal studies in humans are available as of now. This diet has been rendered safe for a wide range of subjects but, some side effects and limitations do exist.

Various animal studies have proved the anti-inflammatory and pain-relieving effects of this diet. A wide range of mechanisms in humans has been hypothesized by researchers which seem promising.

However, there is no concrete evidence to support the benefits of the ketogenic diet in rheumatoid arthritis as it requires long-term clinical trials in a large number of the human population.